MARK THEODORE FNP-BC NPI 1457793135

NPI Information

  • NPI: 1457793135
  • Provider Name: MARK THEODORE, FNP-BC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1656 CHAMPLIN AVE
    UTICA, NY
    ZIP 13502
  • Phone: (315) 624-6000

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NPI Details

Mark Theodore, FNP-BC is a family nurse practitioner in Utica, NY. Mark Theodore, FNP-BC NPI is 1457793135. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1656 CHAMPLIN AVE
UTICA, NY
ZIP 13502-830
Phone: (315) 624-6000

The NPI 1457793135 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 7/23/2013 and was last updated on 7/23/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163WC0200XRegistered NurseCritical Care Medicine629932NEW YORKNo
2363LF0000XNurse PractitionerFamily338083NEW YORKYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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